MICHELE  DOWNEY  &  ASSOCIATES  

Jerry Cullins PsyD Michele Downey RN LMFT For NAACD December 2011

dedicated to the memory of Jim Holes CAC, MFT

Inspire Others

Work Smart

We know it works… we

did it!!

CORE  IDEAS  ABOUT  COMMUNITY  INTERVENTION  

WHEN  WE  UNITE  A  COMMUNITY…  WE  ALL  WIN  

Each of us know our own field of expertise very well…;

yet, most of us don’t develop ongoing relationships with others in the various

disciplines… so we encounter a bureaucratic nightmare when we try to

accomplish our goals… and we don’t know the GATEKEEPERS.

WHEN  WE  WORK  SMART  

1.  We collaborate, build partnerships, increase productivity, and

deliver quality results… to help intervene on the various addictions

and mental illnesses with at risk children, adolescents and adults.

2.  We used the same principles that Dr. Vernon Johnson used when

he educated his Board of Directors about Intervention( when many

of the members themselves were practicing alcoholics) and

Family Systems Theory.

COMMUNITY  COMPONENTS  

LEGAL…  POLICE/SHERIFF…  PROBATION

MEDICAL…  DOCTORS,  NURSES,  HOSPITALS,  CLINICS

SCHOOL…  K-­‐12,  UNIVERSITY,  PRIVATE/PUBLIC

SOCIAL  SERVICE.  MENTAL  HEALTH  WORKERS/AGENCIES  

THE  MAGIC:  FINDING  THE  GATEKEEPERS  

The Gate Keeper is the “power source” to the Component System.

Identify the Gate Keeper and connect with that person.

They will guide you through their unique system…

who is important… who to watch for.

“It took me 20 years to unify the first SAP Community in North Dakota… You can do it quicker!”

~Dick Shaeffer of “Choices and Consequences”

WE  ARE  EITHER  THE  GATEKEEPERS  TO  OUR  SYSTEMS,  OR  WE  KNOW  WHO  THEY  ARE  

Our ability to bond and create ongoing relationships to other gatekeepers of the various systems is what speeds up the community intervention work.

INTERVENTION      

•  Identify problems by a Core Team

•  Intervene with standard protocol

•  Refer to appropriate person (not agency)

Identify

Refer Intervene

SERIES  OF  WORKSHOPS  AIMED  AT  UNITING  SYSTEMS  

Each system sends a key representative to the educational workshop. •  Basic generic starter kits with form letters advising of the need/call to action •  Basic education re: addiction/mental health/resources/research and peer

contact Goal is to create education and sensitivity to the unique problems within the system and for “Doing the Right Thing”. First, role play an in vivo re-enactment of a “referral” -- each system or group must attempt to “do the right thing”. This leads to an understanding of the confusion and problems within that system. Then, repeat the role playing with an actual “consultant” from that system, and analyze/process this.

BASIC  STEPS  FOR  ESTABLISHING  A  SAP  CORE  GROUP  

Can be ANYONE who wants to be involved… from

educator, administrator, nursing assistant or teacher’s aide,

librarian, probation officer, etc…

(KEY: they are teachable, and willing.)

22  STEPS  TO  FINALIZING  THE  COMMUNITY  SAP  

1.  Investigate the power sources within the system 2.  Establish a relationship 3.  Investigate the monetary, budgetary and fiscal constraints 4.  Investigate current procedures, policies, legalities and work already existing

or in place. 5.  Evaluate team members most effective and advantageous 6.  Actively solicit, market, sell advantages for being part of the team. 7.  Connect and maintain connections with other core team members. 8.  Establish resource contacts during this time 9.  Introduce your team to what you know and who you know 10. Define various roles/jobs

CONTINUED  BASIC  STEPS  TO  CORE  TEAM  11.  Outline various components to start with (e.g. referral system) 12.  Establish a philosophy and Master Goal List. 13.  Document it and have a foundation for the policy and procedure manual 14.  Investigate -- search and compare with what others have done. 15.  Establish a priority system 16.  Establish a time line 17.  Define a documentation, collection and assessment system. 18.  Materialize some forms for these systems. 19.  Define an in-system support… start with biggest problems first. 20.  Establish an in-house communication and referral system. 21.  Investigate resources for community referral and an evaluation system. 22.  Create a grading system from the referral and assessment systems in-house to outside

systems and connect all documentation, contracts, policies and procedures together.

ADVICE  TO  CORE  PARTICIPANTS  

1.  Guiding not controlling 2.  Can’t be all things to all people… Give self a break. 3.  Use resources creatively… don’t overlook what’s closest to home. 4.  Delegate whenever possible. 5.  Have a philosophy/spiritual base to work from even if it’s group power process

(which gives meaning during tough times). 6.  Never try to do it alone or without support. 7.  Steer away from negativity, doom, and gloom. Stick with the winners. 8.  Remain teachable. 9.  Work on the footwork. Work with the plan, not for the outcome. 10. Know what’s in it for YOU (examine motives & expectations, prevent burn-out!)

THE  SAP  PROCESS:  INTERVENTION  STEP  ONE  

Contract A

•  “We want to see XYZ by ___ date, or PQRS consequences will occur.” •  “We have seen ABC behaviors and documentation.” •  “You have __ period of time to change these behaviors, or we perceive this

as a cry for help.” •  “If PQRS consequences and ABC behaviors occur consistently for ___

period of time then Contract B will go into effect.”

Contract B

•  “Since the following behaviors and documentation have occurred, we are concerned.”

•  “We have been recommended to do XYZ by ABC authorities.” •  “Therefore, we’d like to see XYZ by ___ date, or PQRS consequences will

occur and ABC privileges will be removed.” •  “If PQRS consequences due to ABC behaviors (listed) continue over __

period of time then, Contract C will go into effect.

THE  SAP  PROCESS:  INTERVENTION  STEP  TWO  

THE  SAP  PROCESS:  INTERVENTION  STEP  THREE  

Contract C

•  “Since the following contracts, behaviors, and documentations have occurred, we are concerned.”

•  “We have been recommended to do XYZ by ABC authorities.” •  “We are following through on XYZ consequences and recommending your

parents do XYZ in order to help you, and help themselves.” •  “…and you need to do XYZ to prevent Contract D from occurring.” •  (Lots of in-house groups, education and support.)

THE  SAP  PROCESS:  INTERVENTION  STEP  FOUR  

Contract D

•  Out of house (maybe they could come on campus to your facility) •  Outpatient or free assessment…

THE  SAP  PROCESS:  INTERVENTION  STEP  FIVE  

Contract E

•  12 step meetings associated with the problem(s) and/or peer support. •  Outpatient support, and other items such as counseling.

THE  SAP  PROCESS:  INTERVENTION  STEP  SIX  

Contract F

•  Inpatient locked, or longer incarceration.

THE  SAP  PROCESS:  INTERVENTION  STEP  SEVEN  

Contract G

•  Inpatient locked (again), state facility, or foster home, etc… •  …or other alternative.

A  NATURAL  PROGRESSION  OF  CONSEQUENCES  

•  Truancy, failing grades, make-up classes, don’t graduate on time, summer school make-up, suspension, expulsion, juvenile referrals, probation, home trouble, consequences, physical health failing, more trouble, legal, physical, mental, financial, spiritual consequences… pregnancy, accidents, abortions, disease, death, etc…

•  Pain from doing it the same way, over and over again, expecting different results; more pain and more consequences; trying something different; less pain; trying something different out of desperation or forced… less pain… accepting… less pain… surrender.

A  NATURAL  PROGRESSION  OF  TREATMENT  

•  Meetings with goals, treatment plans, expectations, concerns, documentation and a follow-up meeting.

•  Recommendations on how to meet expectations. •  Follow up appointment… to praise; or to send to the next level Contract B. •  Increased support for efforts at home or school; increased obligation to work on

the problem; tangible things to look for as evidence of change. •  Listen to what they DO, not what they SAY. •  Increased support for finding additional types of help/resources; first in schools,

then in community, for both student(s), and then for family. •  Follow through on rules and regulations. Explain “why” to parents (“tough love"). •  Suspension and expulsion, but with a plan for re-entry to the system if XYZ

happens. •  Re-entering the system after treatment, with expectation for them to assist

helping others with the same problem, in groups or service activities, as a condition for re-entry.

RESULTS:  20  YEARS  LATER  IN  IMPERIAL  COUNTY  

•  The Core Genesis Groups are ongoing today 20 years later within all 32 separate schools and 14 school districts.

•  Relationships were established, and have been ongoing within all the systems. •  All the community components were connected within a two year period. •  Interventions at all levels occurred as we were doing the workshops; not just

with the school systems, but also among the participants.

Some high level administrators recognized their own problems with alcohol/addictions, co-dependency, or mental health issues; some within their family systems. These were given resources to get the help they needed, and to protect their privacy at the same time. They were thus better able to help those with whom they worked or served.

WE  CAN  CHANGE  THE  WORLD  ONE  COMMUNITY  AT  A  TIME…  

…so that our children can enjoy the recovery and beauty that we have been blessed with while breaking the multi-generational chain of dis-ease.